Specialties 3 industry leaders think are still great for ASCs

At Becker's ASC 25th Annual Meeting: The Business and Operations of ASCs in Chicago Oct. 18, three executives from the ASC industry spoke about their strategies when it comes to adding speciality services to centers.

1. Beth LaBouyer, RN, executive director at Sacramento-based California Ambulatory Surgery Association, on what specialities make the most sense for ASCs in California: California's broad geography [makes it] very different from Northern California to Southern California. It really does capture a very different market. So it depends where the centers are ... and your payer mix and your patient population.

Obviously I think orthopedics and spine are the big procedures to add, but the other specialties still have a lot of viability, like GI and ophthalmology. You need to make sure you don't build a speciality all around one physician or one surgeon, because that's very challenging if a surgeon leaves. You want to make sure you can maximize that specialty.

2. Bruce Foerster, MD, orthopedic surgeon and medical director of San Diego Outpatient Surgery Center, on adding total joints and spine services: [San Diego Outpatient Surgery Center is] 45 years old. The ASC was showing its age. We were perfectly equipped for ASC cases that have been appropriate for ASCs over the years, but we were really not appropriately equipped to deal with total joints and spine cases and the larger cases we are interested in.

We saw our caseload was stagnant. We made the unanimous decision after a long, thoughtful process to move into a bigger space. We're doubling our square footage in our ORs. We're going to be opening up and diversifying what we have to offer. But also our overhead is going to be climbing significantly.

3. Bill Stewart, area vice president of value-based purchasing of DePuy Synthes, a Johnson & Johnson company, on which specialities are growing the most: When you're talking about orthopedics and neurosurgery … we're trying to migrate [as many procedures as possible] into the outpatient space. We've seen double-digit growth in spine. We've seen double-digit growth in elective trauma — foot, ankle and wrist — and knees, double-digit growth. All categories are growing rapidly in the outpatient space.

Spine has been an interesting one for us to watch. What we've seen with spine is that surgical procedures that are migrating outpatient, typically one- to three-level ACDF and discectomy, are moving outpatient. But lumbar spine is much slower to move outpatient. What we've seen with lumbar spine is a small number of sites are doing it. A lot of that is because it's capital intensive to do lumbar spine.

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